The Great Hormone Debate

By Gwyn Herbein
While the mythic fountain of youth has eluded us, we are, overall, living longer than previous generations. The average life expectancy in the United States is now 78.5 years, but according to the journal Science, about seven in 1,000 people will live to be 100 years old. Most people know that a sensible diet and plenty of exercise are key components to living a long and healthy life, but there are other aspects that may not be so easy to control.

One of the most controversial of these elements is that of our hormone levels. Over the course of our lives, these levels fluctuate and change. The extent to which these fluctuations are natural, as well as the extent to which we should attempt to regulate them via hormone replacement therapy (HRT), has been the subject of ongoing debate. Two years ago, the commonly accepted practice of HRT in post-menopausal women suddenly became anathema after researchers uncovered a link between HRT and the incidence of breast cancer. While studies on HRT for women have been commonplace in the literature for years, less research is being done on the effects of testosterone therapy for men. Despite that fact, advertisements for the treatment of “low T” are plastered all over magazines and blaring from the TV. The jury may still be out on the long-term effects of HRT, but learning to deal with natural hormone fluctuations in a vitalistic way can protect your body from the potentially harmful effects of synthetic hormones and increase the chances of living a long and healthy life.

Understanding Hormones
Researchers have long sought the answer to questions about hormone levels and their effects on our behavior and health. Charles-Édouard Brown-Séquard, a mid-19th century Mauritian physiologist and neurologist, is often credited with establishing the field of endocrinology. In a letter to the medical journal The Lancet, Brown-Séquard describes injecting himself with a mixture of water, blood from testicular veins, semen and liquid extracted from the testicle of a dog in an attempt to regain vitality and sexual prowess. He reported the experiment to be a success, although later research suggested that his perceived vitality was actually caused by the placebo effect.

The field of endocrinology has come a long way since Brown-Séquard’s experimentation, as we now better understand the inner workings of the various hormone systems. In men, testosterone is an important sex hormone that, during puberty, helps spur the development of typical male attributes such as facial hair and muscle mass. However, its role in middle age and beyond remains unclear. In all people, hormone levels naturally fluctuate from hour to hour and day to day, so it is difficult to accurately define “normal” when it comes to these levels. “We know that men throughout their aging process have, on average, a slow decline in testosterone levels and a more rapid decline in free testosterone levels, which is the active form of the hormone testosterone,” explains Amin Sabet, M.D., a Boston-area endocrinologist and a member of the American Association of Clinical Endocrinologists. “It’s really not known if that process of declining hormone levels is adaptive, meaning favorable, or something which is not favorable.” He also says that testosterone testing is not standardized across different laboratories, and that in combination with natural fluctuations, it can be very difficult to determine where men fall on the scale of normal levels.

This uncertainty and lack of standard testing protocols has led to a hodgepodge of disparate research that confuses, rather than clarifies, the issue. Sabet notes that the benefits of treating men for age-related decline in testosterone is unclear. “Larger, longer-term, randomized, controlled studies are needed to show what benefits are there for men who have age-related, mildly low testosterone levels,” he says.

Yet research has already been disseminated that supports the idea that there may be evolutionary reasons for hormone fluctuations. A study published in 2011 in the Proceedings of the National Academy of Sciences (PNS) found that testosterone levels dropped sharply after men became fathers. The study measured the testosterone levels of 600 men in the Philippines when they were 21 years old and single, and then again nearly five years later. Men who spent more than three hours per day caring for children had the lowest levels of the group.

The “Low T” Phenomenon
The PNS study seems to suggest that reduced testosterone levels are better for sustaining a family life. But what happens to those levels as men continue to age and perhaps become empty-nesters who are no longer responsible for raising children? According to popular culture, these men are prone to suffering from “low T,” a testosterone deficiency that causes fatigue, low libido and increased body fat. According to André Guay, M.D., a clinical assistant professor at Harvard Medical School and director of the Center for Sexual Function at Lahey Clinic Northshore, between 4 and 5 million American men suffer from low T and this problem can have dire consequences. In a live discussion forum hosted by washingtonpost.com in April 2006, Guay said, “There is mounting evidence linking low testosterone levels to long-term medical conditions such as metabolic syndrome, type 2 diabetes, coronary heart disease, osteoporosis and depression.”

Research supporting these claims remains sparse, at best. After all, it is likely that either lifestyle or HRT can be just as detrimental to health as low hormone levels, resulting in the perennial chicken and egg question. “For most men who see me because of a commercial for low T, their levels are only mildly low, and many of those men are overweight, have diabetes or sleep apnea,” Sabet says. “Those are three conditions where we see an increased prevalence in low testosterone. In many cases, testosterone levels will rise with lifestyle modifications, like weight loss and regular exercise, as well as, to a certain extent, treatment of sleep apnea. When those associated issues are present, I try to treat those before trying the testosterone therapy, and the results have been positive.”

To HRT or Not to HRT
Sabet’s experience lends credence to the idea that HRT may not be the way to go when it comes to dealing with hormone levels. “It’s going to take large, controlled trials to answer [the questions we have about HRT for men],” he says. “There is a 12-center, 800-man study currently underway called ‘The T Trial’ that will answer some of our questions of the efficacy about testosterone therapy, but not all of our concerns about the safety of testosterone therapy.” Similar to the concerns raised by HRT in women, there are some questions as to whether or not testosterone therapy increases the risk of prostate cancer in men.

Testosterone is not the only hormone used to treat symptoms of aging. Human growth hormone, or HGH, has also been marketed as a potent anti-aging treatment. According to a commentary published in the Journal of the American Medical Association in October 2005, worldwide annual sales of HGH were estimated to be between $1.5 billion and $2 billion. While HGH has been shown to improve muscle mass and reduce body fat, it can also increase the risk of cancer, diabetes and even carpal tunnel syndrome. It is also worth noting that HGH is most often illegally prescribed off-label and many athletes use it in conjunction with anabolic steroids.

Natural Aging
While the medical community dukes it out over the efficacy of HRT in men and women, Chiropractic can play a role in helping us look at hormone fluctuations vitalistically. The first step is to understand the relationship between the body’s different systems. “The hormonal system, which basically regulates body chemistry, is controlled by the nervous system,” says Eric Plasker, D.C., author of “The 100 Year Lifestyle.” “What happens is that with interference, like vertical subluxations, the body’s communication is less than what it’s supposed to be. The body will not balance the hormones properly based on what it’s reading and registering in the chemistry.” In the case of hormones, says Plasker, the endocrine system may make adaptations based on misinformation, which can in turn lead to hormonal imbalances.

Plasker suggests making appropriate lifestyle changes, especially in the areas of diet and exercise, as you age, as a way to create balance within the body. “Good nutrition is important as part of a lifestyle because you supply the building blocks for the body to produce what it needs,” including proper hormone levels, he says. He also says that, as a society, we need to make a mental transition from crisis care to lifestyle care. “The hierarchy of the 100-year lifestyle is self care first, health care second (proactive care, getting your teeth cleaned) and crisis care last,” he explains. “Many people require a crisis to bring their attention to lifestyle changes that need to be made. For many people, avoiding crisis care altogether is possible.” Plasker says chiropractors need to be more effective at communicating the importance of lifestyle to their patients. After all, it has been well documented that stress affects hormone levels, which can lead to other health problems.

The “low T” phenomenon, though not always backed by scientific evidence, may be proof that our culture is caught up in the misconception that aging is something to be avoided. It has also fallen out of step with the idea that our bodies and their systems know what they are doing when it comes to life patterns. While no one has yet discovered the fountain of youth, by taking care of our bodies through natural means, and accepting aging as an inevitable part of life, we may be able to live healthier lives than ever before.